Masters of Bedlam: The Transformation of the Mad-Doctoring Trade

“There is no such thing as society,” Mrs. Thatcher once famously remarked. She was being silly, of course, but as this fine monograph demonstrates, a great deal can be learned about society by the careful study of individuals within it. Andrew Scull and his coauthors have used the lives and careers of seven British psychiatrists to produce a subtle and rich addition to our knowledge of how the insane were perceived and dealt with during the long nineteenth century.

Psychological medicine in Britain produced no nineteenth-century clinician of the caliber of Esquirol, Griesinger, or Wernicke, but the exemplars in this monograph have been well chosen: their careers span the century, and the range of issues with which they were involved pretty much covers the British waterfront. The latter include the place of the asylum in the psychiatric landscape, the pros and cons of nonrestraint, the relative merits of lay and medical input into the psychiatric system, psychiatric education, and the nature of insanity itself. On no issue was there professional unanimity, even among the small group of mad-doctors whose lives are here explicated.

Two of these individuals—John Conolly (1794–1866) and Henry Maudsley (1835–1918)—are among the best-known alienists of the period, yet both present enigmas. Conolly was an intellectual butterfly whose stint as medical superintendent at Hanwell (where he introduced the nonrestraint system that had been pioneered by Robert Gardiner Hill at the Lincoln Lunatic Asylum) lasted a mere four years. He was savagely lambasted in Charles Reade’s sensationalist novel Hard Cash (1873), yet was placed with Jenner and Lister in the pantheon of British medicine. Intellectually, Maudsley was more like a leech, tenaciously expounding his pessimistic, materialistic, and nihilistic philosophy of the human condition—much to the discomfort of many of his colleagues, who hated his arrogance and caustic tongue and pen. Nevertheless, his consulting psychiatric practice was so successful that he became wealthy enough to endow the hospital that still bears his name.

John Haslam (1764–1844) is generally remembered as the Bethlem apothecary who was dismissed in the wake of the 1815 Parliamentary enquiry into the appalling conditions in Bethlem and other psychiatric hospitals. Yet, he was a remarkably subtle clinician whose writings compare favorably with those of any other individual included in this volume. By contrast, W. A. F. Browne (1805–85) was a one-book man, although his What Asylums Were, Are, and Ought To Be (1837) beautifully captured the naive optimism of the early Victorian asylum movement. Like Sir John Charles Bucknill (1817–97), Browne was lured away from asylum-keeping by the rewards of higher psychiatric administration: Browne became one of the Scottish Lunacy Commissioners, and Bucknill the Lord Chancellor’s Visitor in Lunacy, from which position he began to advocate the boarding out of psychiatric patients. Samuel Gaskell (1807–1886) had only brief asylum experience before he was appointed to the English Lunacy Commission; his career, like Browne’s, was cut short by an accident. Finally, Sir Alexander Morison (1779–1866) would have been suited to the peripatetic life of a lunacy inspector, flitting as he did between Edinburgh, Paris, and London. Instead, he attempted unsuccessfully to make psychiatry an integral part of medical education and held visiting appointments at a number of psychiatric establishments—including Bethlem, where his portrait was painted by its most famous patient, Richard Dadd. Morison’s surviving diaries and correspondence provide an unusual gloss on the highs and lows of psychiatric practice during the period.

Although based on these seven lives, this volume offers much more than simply a series of disparate biographical studies. By integrating their themes and probing into the social, domestic, and professional realities of their subjects’ worlds, Scull, MacKenzie, and Hervey have produced a telling analysis of British psychiatry in the making.